Epicardial Fat: Definition,Measurements and Systematic Review of Main Outcomes

Epicardial fat (EF) is a visceral fat deposit, located between the heart and thepericardium, which shares many of the pathophysiological properties of other visceralfat deposits, It also potentially causes local inflammation and likely has directeffects on coronary atherosclerosis. Echocardiography, computed tomography andmagnetic resonance imaging have been used to evaluate EF, but variations betweenmethodologies limit the comparability between these modalities.We performed a systematic review of the literature finding associations of EF withmetabolic syndrome and coronary artery disease. The summarization of theseassociations is limited by the heterogeneity of the methods used and the populationsstudied, where most of the subjects were at high cardiovascular disease risk.EF is also associated with other known factors, such as obesity, diabetes mellitus,age and hypertension, which makes the interpretation of its role as an independentrisk marker intricate. Based on these data, we conclude that EF is a visceral fatdeposit with potential implications in coronary artery disease. We describe thereference values of EF for the different imaging modalities, even though these havenot yet been validated for clinical use. It is still necessary to better definenormal reference values and the risk associated with EF to further evaluate its rolein cardiovascular and metabolic risk assessment in relation to other criteriacurrently used.